Effects of Foot Reflexology on Severity of Pain and Opioid Dosage Administered to Patients Undergoing a Discectomy: A Randomized Clinical Trial
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
http://www.cjmb.org
Open Access Original Article
Crescent Journal of Medical and Biological Sciences
Vol. 8, No. 3, July 2021, 209–214
eISSN 2148-9696
Effects of Foot Reflexology on Severity of Pain and Opioid
Dosage Administered to Patients Undergoing a Discectomy:
A Randomized Clinical Trial
ID ID
Mehdi Khanbabayi Gol1 , Davoud Aghamohamadi2*
Abstract
Objectives: The present study aimed to investigate the effects of foot reflexology on the severity of pain and opioid dosage
administered to patients undergoing a discectomy.
Materials and Methods: The present randomized clinical trial (concurrent parallel) was conducted including two experimental
groups. In general, 60 patients were selected from Imam Reza and Shohada hospitals of Tabriz based on convenience sampling
and then randomly assigned to the intervention (n=30) and control (n=30) groups based on randomly permuted blocks. Four hours
after the surgery and the last dosage of pethidine, patients in the intervention group received massaging of both feet 20 minutes per
day for 2 days while those in the control group received no intervention. The data were collected using a demographics and visual
analogue scale (VAS) checklist and then were statistically analyzed using chi-square, Fisher exact test, and the independent t-test
in SPSS-21 at the 0.05 level of significance.
Results: After the intervention, the severity of pain significantly reduced in the intervention group (P < 0.001) but it did not change in
the control group (P > 0.410). The results indicated no significant difference between the two groups in pre-intervention pethidine
dosage (P > 0.490). After the intervention, pethidine dosage significantly decreased in the intervention group on all days (P < 0.001),
but no significant change was observed in the control group (P > 0.499).
Conclusions: Considering the positive effects of foot reflexology on the severity of pain and reduced dosage of the required opioids
for pain control, this technique is recommended to be used as a perfect complementary therapy, along with other treatments to
reduce postoperative pain in patients undergoing a discectomy.
Keywords: Foot reflexology, Discectomy, Severity of pain, Opioids
Introduction less used for patients undergoing surgery on their spinal
Surgeries on the spinal column are considered among cord (4,5). On the other hand, some studies have reported
the most painful medical procedures. Due to extensive that foot reflexology cannot properly reduce postoperative
neurological damages in such surgeries, postoperative pain (6,7). Regarding the complications of opioid drugs
pain control is quite important to both physicians and and the fear of using these drugs, the use of non-
patients. Improper pain control in such patients can lead prescriptive methods is necessary for reducing pain after
to undesirable outcomes (1). a discectomy. In addition, there are a few studies about
Supplementary therapies such as massage act as the effects of foot reflexology on the severity of pain after
a supportive intervention for improving all painful a discectomy and surgeries of the spinal cord. Therefore,
experiences during hospitalization. Reflexology or foot the present study mainly aimed to evaluate the effects of
massage is a natural and old treatment. Reflexologists foot reflexology on the severity of pain and opioid dosage
believe that all body organs and glands are connected to administered to patients undergoing a discectomy.
reflex areas on the feet, hands, and ears (2). They claim
that they can reduce tensions, improve blood circulation Materials and Methods
and normal functioning of related areas, and finally, The current randomized clinical trial (concurrent parallel,
reduce pain in the corresponding body parts by applying double-blind) included two experimental groups in order
pressure to the feet and hands with specific thumb, finger, to determine the effects of foot reflexology on the severity
and hand techniques without the use of oil or lotion (3). of pain and opioid dosage administered to patients
Although the desirable results of foot reflexology have undergoing a discectomy. The inclusion criteria were a
been observed in some surgeries, this technique has been minimum literacy level of writing and reading, lack of
Received 10 January 2019, Accepted 16 June 2019, Available online 23 August 2019
1
Responsible for the Nursing Research Committee of Imam Reza Hospital, Nursing and Midwifery Faculty, Tabriz University of Medical
Sciences, Tabriz, Iran. 2Department of Anesthesiology, School of Medicine, Imam Reza Medical, Tabriz University of Medical Sciences
*Corresponding Author: Davoud Aghamohamadi, Email: dr.daghamohammadi@yahoo.comKhanbabayi Gol and Aghamohamadi
Key Messages participants were admitted to the brain surgery ward, their
severity of pain was measured and recorded using the VAS
►► The pain after discectomy is very severe.
►► Attempt to control pain after discectomy is non-
checklist and those with a score of 3 or more were selected
pharmacological. for the study. Then, foot reflexology was performed by a
►► Foot reflexology led to the control of pain after discectomy. skilled physiotherapist for 20 minutes for each patient in
a separate room. First, the physiotherapist attempted to
establish a friendly relationship with patients by taking
their medical history and then asked them to comfortably
having a surgical procedure other than a discectomy, no lie down in a prostrate position. Before starting the
history of foot reflexology, no history of taking sedatives, massage, the physiotherapist washed his/her hands with
analgesics, or anxiolytics such as Inderal (propranolol) lukewarm water and dipped them into a baby oil with no
for more than a month, non-addiction to drugs, non- healing value, and then cleaned the patients’ feet with a
affliction with known diseases such as cardiovascular wet towel. The foot massage consisted of 20 actions in
diseases, diabetes, visual impairment, and hearing loss, 3 steps. First, the right foot was massaged with the first
the health of feet, and a score of 3 or more on the visual 6 actions that generally lasted 1.5 minutes (each action
analogue scale (VAS) checklist. On the other hand, the lasted 15 seconds). The right foot was covered with a towel
exclusion criteria included preoperative complications and the same actions were performed on the left foot for
such as severe bleeding or acute infection, the need for 1.5 minutes. After covering the left foot, the second 6
admission to the intensive care unit, and lack of complete actions were performed on both feet for 1.5 minutes. The
consciousness during the intervention. In addition, other third step included 8 actions that were simultaneously
exclusion criteria were unpleasant feelings and complaints performed on both feet in 7 minutes. In this step, the
during the intervention, an unwillingness to continue first two actions were performed in 1 minute and each of
the study, the need for taking painkillers more than the the next actions lasted for 1 minute. Specialized massage
routine, and the arbitrary use of painkillers by patients. exercises including rubbing, rotating, stretching, gripping,
The study population consisted of patients undergoing and bending were performed on different parts of the
a discectomy who were willing to participate in the study. foot from the ankle to toes for 20 minutes (10 minutes
The participants were selected based on convenience for each foot) once a day for 2 consecutive days (12). The
sampling from patients meeting the inclusion criteria in first massage exercise was performed at 5-9 pm at least 4
Imam Reza and Shohada hospitals of Tabriz. The sample hours after the surgery and the second one was performed
size was determined based on a sample size formula 24 hours later at the same time. In the control group, the
considering a confidence level of 95% and a test power of physiotherapist was present at the patients’ bedside and
80% (8). As a result, 30 patients undergoing a discectomy attempted to establish a friendly relationship with patients
were selected from each hospital (15 patients for the by taking their medical history in order to determine the
intervention group and 15 patients for the control group). pure effect of massage on pain reductions by controlling
Considering an attrition rate of 20%, a total of 60 patients the effect of the masseur’s presence. Thirty minutes
were selected from the 2 hospitals for the study (8). The after the 2 sessions of intervention, the assistant author
participants were assigned to intervention and control measured and recorded the patients’ severity of pain
groups based on randomly permuted blocks. using the VAS checklist. All patients received analgesics
The required data were collected using a demographics according to the routines of the studied hospitals and
form and the VAS checklist. Demographic characteristics there was no difference between the 2 groups in this
included age, gender, occupation, educational attainment, regard. The pethidine dosage administered to patients
marital status, number of children, anesthetic status, was recorded 11 hours before and after the intervention.
number of postoperative suppositories, height, weight, It is noteworthy that the author, the data analyzer, and the
body mass index (BMI), and the pethidine dosage physician were unaware of grouping and intervention.
consumed within 48 hours after the surgery. VAS is Ethical considerations were fully observed like
a visual scale as a horizontal ruler graded from 0 to 10 other studies (13-15). All patients were briefed on the
that measures the severity of pain. On this ruler, 0 and research objectives and procedure and were assured of
10 denote no pain and very severe pain, respectively (9). discontinuing the study at any stage. Then, an informed
Based on Cronbach’s alpha, the reliability of this scale was written consent form was obtained from all patients. In
obtained 0.89-0.91 (10). Its reliability and validity have addition, necessary arrangements were made with the
been also confirmed in Iran (11). authorities and matrons of the studied hospitals.
The demographic information of participants was
recorded by an assistant researcher who was unaware of Statistical Analyses
participants’ assignment to experimental groups. The Chi-square test and Fisher exact test were used to
participants were trained for using the VAS checklist compare the intervention and control groups in terms
before the surgery. After the surgery and when the of demographics. In addition, the independent t-test was
210 Crescent Journal of Medical and Biological Sciences, Vol. 8, No. 3, July 2021Khanbabayi Gol and Aghamohamadi
employed to compare the two groups regarding the pre- (Table 2), the severity of pain significantly reduced in
and post-intervention mean score of pain. All statistical patients in the intervention group on all days of the study
analyses were performed in SPSS 21 at the 0.05 level of (P < 0.001) while it changed significantly in the control
significance. group in none of the study days (P > 0.410).
The results further demonstrated that there was no
Results significant difference between the intervention and control
In total, 80 patients were identified for the study while groups in terms of the mean pethidine dosage before the
excluding 20 cases due to the lack of entry criteria. After intervention (P > 0.490). However, a significant difference
random allocation to control and intervention groups, was found between the two groups in this regard after the
30 patients received the intervention, none of who were intervention (P < 0.001). The results of the independent
eliminated during the intervention, and statistical analysis t test (Table 3) also revealed that the pethidine dosage
was performed for every 30 people )Figure 1). administered to patients in the intervention group was
The mean age and the mean BMI of patients were significantly lower than that of the control group on all
58.50 ± 8.20 and 29.80 ± 3.2250, respectively. The majority days (P < 0.001).
of patients (n = 48, 80%) were males, half of them (n = 30,
50%) had a high school diploma, 71.66% (n = 43) of them Discussion
were clerks, 71.66% (n = 43) of them were married, and The present study aimed to investigate the effects of foot
all of them (n = 60, 100%) were under general anesthesia. reflexology on the severity of pain and opioid dosage
Table 1 presents the results of the chi-square test and the administered to patients undergoing a discectomy.
independent t-test for comparing the intervention and Researchers believe that massage therapy and reflexology
control groups in terms of demographics. are simple and learnable treatments that can be applied
The results of the independent t-test showed that there to a wide range of clinical problems. Because of its
was no significant difference between the intervention and simple and easy nature, reflexology can increase patients’
control groups in terms of the pre-intervention severity involvement in self-care (16). On the other hand, studies
of pain on the first, second, and third days (P > 0.419). have shown that reflexology can reduce anxiety, improve
However, there was a significant difference between the components of life quality and sleep quality, and relax
the two groups in severity of pain after the intervention the patient by reducing the severity of pain (17). In the
(P < 0.001). Based on the results of the independent t test present study, foot reflexology managed to reduce the
Enrollment Assessed for eligibility (n=80)
Excluded (n= 20)
Not meeting inclusion criteria (n=20)
Randomized (n=60)
Allocation
Allocated to intervention (n=30) Allocated to intervention (n=30)
Received allocated intervention (n=30) Received allocated intervention (n=30)
Follow-Up
Lost to follow-up (n=0) Lost to follow-up (n=0)
Discontinued intervention (n=0) Discontinued intervention (n=0)
Analysis
Analysed (n=30) Analysed (n=30)
Figure 1. The Flow Chart of the Recruitment and Retention of Participants.
Crescent Journal of Medical and Biological Sciences, Vol. 8, No. 3, July 2021 211Khanbabayi Gol and Aghamohamadi
Table 1. Comparison of Patients in the Intervention and Control Groups in Terms of Demographics
Intervention Control
Variables P Value
Mean±SD Max Min Mean±SD Max Min
Age (year) 59.75±8.45 70 45 60.25±8.50 77 46 0.495
Weight (kg) 85.90±12.20 92 75 87.20±11.30 90 69 0.505
Height (cm) 169.50±15.45 186 157 163.50±14.59 182 153 0.611
BMI (kg/m ) 2
31.15±3.10 22.30 35 29.15±3.15 25 36.1 0.399
Occupation (n, %)
Housewife 9-30% 8-26.66%
0.7
Clerk 21-70% 22-73.34%
Educational attainment (n, %)
Less than high school 5-70% 7-70%
High school 16-70% 14-70%
0.523
University degree 9-70% 9-70%
Number of children (n, %)
0-2 28-93.33% 26-86.66%
0.7
2-4 2-06.64% 4-13.34%
Anesthesia status (n, %)
General anesthesia 30-100% 30-100% 1
Table 2. Comparison of Patients in the Intervention and Control Groups in Terms of Severity of Pain
Day Intervention (Mean±SD) Control( Mean±SD) P Value
Before the intervention 04.75±0.33 04.82±0.60 0.565
First After the intervention 2.88±0.15 04.78±0.55Khanbabayi Gol and Aghamohamadi
that reflexology had positive effects on the reduction of affect the results. Compared to other studies conducted in
pain and proper management of postoperative pain (8). this area, one of the strengths of the present study was the
In another study conducted by Lalehgani et al, it was presence of the physiotherapist, along with the patients in
shown that foot reflexology had positive and beneficial the control group in order to determine the pure effect
effects on post-discectomy pain management. They also of massage on pain reductions by controlling the effect
concluded that this technique can be widely used as a of the masseur’s presence. Other strengths of this study
complementary therapy in patients undergoing surgery included the homogeneity of the study groups in terms of
on the spinal cord (1). The results of the above-mentioned gender, type of surgery, type of anesthesia, and analgesics
studies are consistent with the findings of the present dosage administered to patients, random assignment of
study in terms of the positive effects of foot reflexology participants to the intervention and control groups, and
on postoperative pain management. Other studies about unawareness of the assistant researcher about grouping
the effects of reflexology on patients undergoing heart and interventions.
surgery (18), thoracic surgery (19), and cesarean section
(20) also reported similar results. Eghbali et al evaluated Suggestions for Future Studies
the effects of foot reflexology on the severity of low back Based on the study findings, future studies are
pain in nurses and showed that reflexology had positive recommended to investigate the long-term effects of foot
effects on reducing low back pain (21). Another finding reflexology and its impact on chronic pains.
of the present study demonstrated that foot reflexology
dramatically reduced the opioids dosage administered Authors’ Contribution
MKG: Study design, intervention; DA: Intervention, submission,
to patients. Consistent with the results of this study, article writing.
Stephenson et al reported a significant reduction in the
opioids dosage administered to patients following foot Conflict of Interests
reflexology (17). Authors have no conflict of interests.
In the present study, foot reflexology had short-term
Ethical Issues
effects on the reduction of postoperative pain, and it
The research project was approved by the Ethics Committee of
again increased on the day after reflexology. Keller et al Tabriz University of Medical Sciences (ethics no. IR.TBZMED.
investigated the effects of 8 weeks of massage therapy on REC.1397.1059) and registered at the Iranian Registry of Clinical
the severity of pain after a discectomy and concluded that Trials website (identifier: IRCT20120605009948N6; https://www.
this technique had short-term effects on pain reductions irct.ir/trial/38485).
and patients’ severity of pain increased after one week
Financial Support
(22). This study was granted by Tabriz University of Medical Sciences.
Conclusions Acknowledgments
Considering the study findings and the further reduction The present paper presents part of the research project approved
of pain severity in the intervention group compared with by the Clinical Research Development Unit of Tabriz University of
Medical Sciences. The researchers would like to give their gratitude
the control group, foot reflexology can be used as a perfect
to the Research Center and the Health Vice-chancellor of Tabriz
complementary therapy, along with other treatments University of Medical Sciences for financial support in the study..
to reduce postoperative pain in patients undergoing
discectomy. Based on the findings, a reduction was found References
in the severity of pain in patients who received foot 1. Lalehgani Ha, Rafiei Z, Yarmohmadi P. The effect of foot
reflexology and the use of complementary therapies did reflexology massage on pain of patients undergoing lumbar
disc surgery in shahrekord hospitals. J Clin Nurs Midwifery.
not cause unwanted side effects in patients. Therefore, 2018;7(1):19-27. [Persian].
massage therapy and reflexology can be used as simple 2. Quattrin R, Zanini A, Buchini S, et al. Use of reflexology foot
and learnable treatments for reducing the severity of pain massage to reduce anxiety in hospitalized cancer patients
after discectomy. in chemotherapy treatment: methodology and outcomes.
J Nurs Manag. 2006;14(2):96-105. doi:10.1111/j.1365-
2934.2006.00557.x
Limitations of the Study
3. Tiran D, Chummun H. The physiological basis of reflexology
One of the research limitations was the difference between and its use as a potential diagnostic tool. Complement Ther Clin
patients in pain threshold which may cause a difference Pract. 2005;11(1):58-64. doi:10.1016/j.ctnm.2004.07.007
in the severity of pain expressed by patients and affect 4. Song HJ, Son H, Seo HJ, Lee H, Choi SM, Lee S. Effect of
the evaluation results. In addition, all answers of the self-administered foot reflexology for symptom management
participants were considered correct and it was possible in healthy persons: a systematic review and meta-analysis.
Complement Ther Med. 2015;23(1):79-89. doi:10.1016/j.
for the author to check all answers. On the other hand,
ctim.2014.11.005
the psychological status, family problems, and physical 5. Song HJ, Choi SM, Seo HJ, Lee H, Son H, Lee S. Self-
conditions of the participants when completing the administered foot reflexology for the management of chronic
questionnaire were not taken into account, which would health conditions: a systematic review. J Altern Complement
Crescent Journal of Medical and Biological Sciences, Vol. 8, No. 3, July 2021 213Khanbabayi Gol and Aghamohamadi
Med. 2015;21(2):69-76. doi:10.1089/acm.2014.0166 14. Movassaghi R, Peirovifar A, Aghamohammadi D,
6. Miozzo AP, Stein C, Bozzetto CB, Plentz RDM. Massage Mohammadipour Anvari H, Golzari SE, Kourehpaz Z.
therapy reduces pain and anxiety after cardiac surgery: Premedication with single dose of acetazolamide for
a systematic review and meta-analysis of randomized the control of referral shoulder pain after laparoscopic
clinical trials. Clin Trials Regul Sci Cardiol. 2016;23-24:1-8. cholecystectomy. Anesth Pain Med. 2015;5(6):e29366.
doi:10.1016/j.ctrsc.2016.11.003 doi:10.5812/aapm.29366
7. Mohammad Aliha J, Behroozi N, Peyrovi H, Mehran A. 15. Bakhshaei MH, Manuchehrian N, Khoshraftar E,
The effect of foot reflexology massage on incisional pain in Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects
abdominal and chest surgery patients admitted to intensive of intrathecal sufentanil added to lidocaine 5% in elective
care unit. Cardiovascular Nursing Journal. 2013;2(2):6-12. cesarean section. Acta Med Iran. 2010;48(6):380-384.
[Persian]. 16. Watson S, Watson S. The effects of massage: an holistic
8. Sahbaee F, Abedini S, Ghandehari H, Zare M. The effect of foot approach to care. Nurs Stand. 1997;11(47):45-47.
Reflexology Massage on pain of scoliosis patients undergoing doi:10.7748/ns.11.47.45.s47
spinal surgery. Anesthesiology and Pain. 2015;5(4):63-71. 17. Stephenson NL, Swanson M, Dalton J, Keefe FJ, Engelke
[Persian]. M. Partner-delivered reflexology: effects on cancer pain
9. Hawker GA, Mian S, Kendzerska T, French M. Measures of and anxiety. Oncol Nurs Forum. 2007;34(1):127-132.
adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric doi:10.1188/07.onf.127-132
Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire 18. Bagheri-Nesami M, Zargar N, Gholipour-Baradari A, Khalilian
(MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), A. The effects of foot reflexology massage on pain and fatigue
Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain of patients after coronary artery bypass graft. Journal of
Scale (SF-36 BPS), and Measure of Intermittent and Constant Mazandaran University of Medical Sciences. 2012;22(92):52-
Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 62. [Persian].
2011;63 Suppl 11:S240-252. doi:10.1002/acr.20543 19. Dion L, Rodgers N, Cutshall SM, et al. Effect of massage on pain
10. Bauer BA, Cutshall SM, Wentworth LJ, et al. Effect of management for thoracic surgery patients. Int J Ther Massage
massage therapy on pain, anxiety, and tension after cardiac Bodywork. 2011;4(2):2-6. doi:10.3822/ijtmb.v4i2.100
surgery: a randomized study. Complement Ther Clin Pract. 20. Khoshtarash M, Ghanbari A, Yegane MR, Kazemnejhad
2010;16(2):70-75. doi:10.1016/j.ctcp.2009.06.012 E, Rezasoltani P. Effects of foot reflexology on pain and
11. Heidari A, Ehteshamzadeh P, Marashi M. The relationship physiological parameters after cesarean section. Koomesh.
between the severity of insomnia, sleep quality, drowsiness 2012;14(1):109-116. [Persian].
and disturbance in mental health and academic performance 21. Eghbali M, Safari R, Nazari F, Abdoli S. The effects of
of girls. Journal of Woman and Culture. 2010;1(4):65-76. reflexology on chronic low back pain intensity in nurses
[Persian]. employed in hospitals affiliated with Isfahan University of
12. Puthusseril V. “Special foot massage” as a complimentary Medical Sciences. Iran J Nurs Midwifery Res. 2012;17(3):239-
therapy in palliative care. Indian J Palliat Care. 2006;12(2):71- 243.
76. doi:10.4103/0973-1075.30249 22. Keller G. The effects of massage therapy after decompression
13. Zomorrodi A, Mohamadipour-Anvary H, Kakaei F, and fusion surgery of the lumbar spine: a case study. Int J
Solymanzadeh F, Khanlari E, Bagheri A. Bolus injection versus Ther Massage Bodywork. 2012;5(4):3-8. doi:10.3822/ijtmb.
infusion of furosemide in kidney transplantation: a randomized v5i4.189
clinical trial. Urol J. 2017;14(2):3013-3017.
Copyright © 2021 The Author(s); This is an open-access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
214 Crescent Journal of Medical and Biological Sciences, Vol. 8, No. 3, July 2021You can also read
